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317:30-5-560.Treatment Plan
[Revised 09-01-15]

(a) An eligible organization must create a treatment plan for the member as part of the authorization process for private duty nursing services.  The initial treatment plan must be signed by the member's attending physician.

(b) The treatment plan must include all of the following medical and social data so that an OHCA physician can appropriately determine medical necessity including use of the Private Duty Nursing Acuity Grid:

(1) diagnosis;

(2) prognosis;

(3) anticipated length of treatment;

(4) number of hours of private duty nursing requested per day;

(5) assessment needs and frequency (e.g., vital signs, glucose checks, neuro checks, respiratory);

(6) medication method of administration and frequency;

(7) age-appropriate feeding requirements (diet, method and frequency);

(8) respiratory needs;

(9) mobility requirements including need for turning and positioning, and the potential for skin breakdown;

(10) developmental deficits;

(11) casting, orthotics, therapies;

(12) age-appropriate elimination needs;

(13) seizure activity and precautions;

(14) age-appropriate sleep patterns;

(15) disorientation and/or combative issues;

(16) age-appropriate wound care and/or personal care;

(17) communication issues;

(18) social support needs;

(19) name, skill level, and availability of all caregivers; and
(20) other pertinent nursing needs such as dialysis, isolation.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.